1 in 6 children with unintentional injuries develops persistent, impairing symptoms of[unreadable] posttraumatic stress disorder (PTSD) but most go undiagnosed and untreated. PTSD and other sequelae[unreadable] can have significant impact on health and functional outcomes, yet medical providers' awareness of injury-related[unreadable] traumatic stress is limited. Hospital trauma programs offer unique opportunities for secondary[unreadable] prevention of persistent psychosociat distress and promotion of optimal health outcomes for injured children.[unreadable] Expert consensus recommendations for PTSD prevention call for stepped care incorporating screening,[unreadable] follow-up with those at risk, and evidence-based interventions that are matched to individual need. Despite[unreadable] the documented impact of pediatric injury-related PTSD, no such program has been evaluated for injured[unreadable] children.[unreadable] Objectives: We propose a randomized effectiveness trial to address the following specific aims:[unreadable] 1) Evaluate the impact of the intervention on psychosocial outcomes (PTSD and depression symptoms);[unreadable] 2) Evaluate its impact on health outcomes (adherence to discharge instructions, health-related quality of life);[unreadable] 3) Provide preliminary data to inform cost-effectiveness analyses: describe the costs of providing the[unreadable] intervention and describe its impact on subsequent health service utilization.[unreadable] We hypothesize that at-risk children receiving the intervention will have lower PTSD and depression scores,[unreadable] better health outcomes, and more appropriate use of post-injury health services.[unreadable] Study Design: Randomized controlled trial comparing Stepped Preventive Care intervention to usual care,[unreadable] with baseline, 6 week, and 6 month assessments.[unreadable] Setting: Urban Level I Pediatric Trauma Center.[unreadable] Participants: 270 children age 8 to 17 admitted for unintentional injury.[unreadable] Interventions: Stepped Preventive Care intervention for at-risk injured children.[unreadable] Outcome Measures: Assessments 6 weeks and 6 months post-injury will evaluate PTSD and depression[unreadable] symptoms in children and parents, adherence, and health-related quality of life. Health record data will[unreadable] gauge adherence with discharge instructions and health service utilization over the 6 months post-injury.